Abraham Verghese’s Cutting for Stone

Dr. Abraham Verghese

chisels away with his fictional scalpel and writer’s pen to discover the meaning of life, living and medicine…

It’s a frenetic juxtaposition of ever-changing airports, taxis, hotels, new places, unknown streets and lots and lots of nameless faces. Indeed, in recent days Dr. Abraham Verghese has been boarding jets at breakneck speed, shuttling between countless cities and towns in North America, not for medical conferences or research but for that quintessential ritual of an author’s life – the book tour.

‘Cutting for Stone’, his monumental first novel has just been published and the accolades are pouring in. A decade in the making, this intriguing tale is keeping readers hooked. Yet on a deeper level, the book is an exploration of medicine, ethics, the relationship of patient and physician and all the dichotomies of the healing profession. It is, in fact, for Verghese, a distillation of all these dilemmas seen through the lens of his own experiences and imagination.

“Fiction is a higher form of truth telling than nonfiction, in the sense that if a novel is compelling it’s usually because it has managed to penetrate some truth about the human condition that is well illustrated by that novel,” says Verghese, who has also written two acclaimed works of nonfiction. “Novels are instruction for living.”

Cutting for Stone by Dr. Abraham Verghese

Indeed right from the start the stethoscope and the writer’s pen have been deeply entwined for Verghese, making him who he is today. Currently he is Professor for the Theory and Practice of Medicine at the Stanford University School of Medicine and Senior Associate Chair of the Department of Internal Medicine in California. He also has two acclaimed nonfiction books and scores of articles in major publications under his belt.

His journey started many years ago in Addis Ababa in Ethiopia where he was born to Indian parents. “I am very much of Indian origin, that’s my culture,” he says. “My parents were part of a large and interesting community in Ethiopia – all teachers – so we grew up very much steeped in that tradition.”

Political turmoil in Ethiopia terminated his medical training and Verghese returned to India to complete his studies at Madras Medical College, and he has many happy memories of deep friendships and family ties there. He says, “I think now I’m coming full circle to my roots in California where frankly there is a huge Indian Diaspora so that it feels almost like I’m reconnecting and re-circling back to the beginning.”

After completing his medical studies in India, he went on to the US for his residency as a foreign medical graduate, and spent three years in Johnson City, Tennessee before doing his fellowship at Boston University School of Medicine and working at Boston City Hospital for two years.

These were the days of the start of the horrific AIDS epidemic and as an assistant professor of medicine he saw first hand the tragedy of AIDS in rural communities and how it impacted so many lives. His hands-on work with dying patients and the relationships he formed affected him deeply. Writing became an emotional outlet and he also enrolled at the Iowa Writers Workshop at the University of Iowa, earning a Master of Fine Arts degree there.

His work next took him to El Paso, Texas where he was professor of medicine and chief of the Division of Infectious Diseases at Texas Tech Health Sciences Center. He lived here for eleven years and this was also where his writing became a serious commitment.

His debut book, ‘My Own Country: A Doctor’s Story’ was a powerful memoir about working with AIDS patients in rural Tennessee, and in the process, finding himself. It was a finalist for the National Book Critics Circle Award and selected by Time magazine as one of the five best books of the year, and was also made into a film by Mira Nair.
His second book, “The Tennis Partner,” about the drug addiction and death of his friend, a young medical student, was a New York Times notable book and a national bestseller. His articles have also appeared in many publications including including Granta, The New York Times and Wall Street Journal.

Ask him how he managed to juggle his work, his writing and his young family in those early years and he says: “I’m not the best example of this – I really think not being able to balance those things well cost me my first marriage; that and an inherent restlessness and the whole HIV experience. So I’m not sure I’m the poster child for balance but I think I’m smarter about it now and I try a lot harder to say no to things.”

“When you’re starting out, it’s much more difficult to do. So the answer to how do I do it all is, frankly I don’t know. I have one motto that I think has been very helpful – You just try and do this day’s work well. Pay attention to that which is in front of you – so if it’s my son, then nothing else exists for me at that moment in my life. I’m not good at this but this is what I try to do.”

Dr. Abraham Verghese with medical students

Abraham Verghese: Writing and Medicine

For Verghese, writing and medicine are closely knit. He says that in medical school you are taught to observe, pick up on details and bring it all into a diagnosis, and these are factors fundamental to the process of writing too.

“I often feel I write in order to understand what I’m thinking – when I start to write, then it starts to emerge, a sort of secondary, tertiary understanding that I wouldn’t have had if I hadn’t tried to write it – so that’s the part of writing that I think is utterly mysterious and enjoyable,” he says.

Verghese has served as the founding director of the Center for Medical Humanities and Ethics at the University of Texas Health Sciences Center in San Antonio, a novel program for medical students. Here he emphasized bedside medicine, inviting medical students to accompany him on rounds, highlighting the value of detailed physical examinations and empathy towards patients and families.

“The humanities are vital in helping students maintain empathy with their patients,” he says. “Students come to medicine with a great capacity to imagine the suffering of others. In their clinical years, however, they are taught to take the patient’s unique story of illness and translate it into the depersonalized language of the chart. We want to keep alive their innate humanity, integrity and empathy.”

Abraham Verghese: Time to Write

And that brings us full circle to Stanford, where he and wife Sylvia moved from Palo Alto with their 10 year old son Tristan. His two older boys, Steven and Jacob, are away at college. His current position at Stanford offers him a rare chance to officially merge his two loves – writing and medicine.

“One of the beautiful things about this position is that for the first time in my life I have a forty percent protected time to write.” he says, “So I’m bringing about the separation of the two roles – something that I never did before. It’s delightful – I feel I’ve finally earned the ability to do that.”

He’s come to Stanford as a professor with tenure and that’s generally something reserved for those with research grants and scientific breakthroughs under their belt. He says, “It’s just very humbling to see how over time the effect of my writing has been that it’s taken to be the equivalent of scientific research. I think it’s looked at as seriously a contribution as research – and that’s really gratifying to me.”

Besides his writing, Verghese is responsible for third year medical students on rotation in internal medicine, something typically delegated to junior faculty: “To me, it’s a great privilege and honor, because it’s precisely the thing that I consider terribly important, a moment to shape them.”

Now that he has a small office of his own and the time to write, Verghese wants to explore with the pen how medicine is evolving and how his own thinking is evolving. “We have never had more ability to bring patients a cure or better their medical conditions, yet I think there has never been a time when patients have been more dissatisfied with medicine.”

“It’s a very strange paradox – science is at this brilliant phase where we are curing some cancers with a single pill but the public, I think, feels quite the opposite, that medicine is getting further and further away from the patient, from one human being interacting with another. It’s more like you’re getting swallowed up by a system when you have an illness and being farmed out to all these tests and specialists.”

He feels the real issue of the day is to balance this almost mathematical, scientific model of disease with our need as human beings to have someone to give us comfort, reassurance and be with us through the course of a long illness. He says, “That’s what intrigues me the most right now.”

Verghese, who has always stayed close to his Indian roots, gratefully recalls his student days at Madras Medical College and his Indian training has a lot to do with his convictions about interactions between physician and patient.

“Even though I knew I was getting very good training, I didn’t realize how precious the kind of training I got in India would be,” he says, recalling the days of in-depth teaching at the bedside with wonderful clinicians – one teacher and 10-15 students, would learn really everything about this one patient, spending an hour or even two, absorbing every detail.

“That has become so rare in America, that when I think back about how I had that happen every single day for three years, in medicine and surgery and obstetrics, I feel very, very blessed,” he says. “I think I had superb medical training – I’m very, very privileged. These clinicians demonstrated that the body is text and showed us how the body can be read. I took it for granted that that’s how everyone is trained everywhere and didn’t realize how rare that was till I got here.”

Indeed, the case of the invisible patient, the I-patient who exists just on the physician’s computer monitor as so much data, while the real live patient in the bed is ignored, has become an important issue for Verghese. His recent article in the New England Journal of Medicine, Culture Shock – ‘Patient as Icon, Icon as Patient,’ addresses this conundrum, as does his novel.

“I think technology – and this is true even in India as well because it’s happening in India very much as well – technology has created the illusion that we don’t need to examine the patient. The argument I make is that if you subscribe to that it’s very, very inefficient and inexpensive; it means that you’re going to not believe someone has lost a finger until you get a Cat scan, an MRI, and an orthopedic consult. It dismisses the ability of the senses to tell you what is going on.”

Dr. Abraham Verghese with a patient

Verghese has a deep belief in this sacrosanct relationship: “I think that there’s a very special transaction that takes place between physician and the patient during the course of a careful examination,” he says. “It’s during that exam when the physician touches you and pulls your eyelid down and looks into your eyes and thumps on your chest – that’s when a very ritualistic bond is formed and if you shortchange that by just sitting behind your desk and saying ‘Let’s send you for this test, let’s send you for that test,’ you have essentially shortchanged yourself from an important transaction.”

“Rituals like that I think are about transformation and if you do it well, the patient is transformed and you are transformed. You have a bond that can only be established by that act. I’m a big believer that that time honored tradition of examining the patient can never become redundant; it can never be something that we just stop doing.”

So this must be a crucial part of what he teaches his students? “It is, and the funny thing is they love it. In this era of technology, it’s almost like being a kind of artisan and preserving an older art form or something! The students uniformly came to medicine imagining that it would be something like this, the sense of being a detective at the bedside. I think that they thrill to someone who can show this to them – they love it and it’s very relevant to them.”

In this age of medical treatment by remote control where the patient is just a faceless number, Dr. Abraham Verghese is attempting to bring the human bond back into the patient-physician pact, and underscoring it with the power of his pen.

TEACHERS WHO TAUGHT THE TEACHER

Abraham Verghese

recalls two professors who were his mentors at Madras Medical College.

“K.V. Thirudengadan, everyone called him KVT – was really my great hero – he showed me how colorful medicine could be and was a wonderful, dedicated teacher. I find myself saying things, sentence for sentence, because he had said them to me in just that way and it was just the right way to say it, just something to make medicine memorable. He would say something to us and we’d be hearing it for the first time and there was such excitement. Teaching is about repetition and he would teach the same thing year after year, making it a little bit better every time, keeping it brand new, keeping it fresh. He was a master at that.

I had a tremendous surgical experience in India as a student with Professor M. Rangabashyan. He was a very charismatic figure, a decisive man, dedicated teacher and a skilled surgeon, very much on the international scene. He was very tough, he had very high standards and I felt that I met his standards and got his approval. I was really quite thrilled to have him interested in me.

When I came to America, I had choice to go to surgery or medicine but decided to go into medicine instead because the prospects seemed better. I was sorry I never got to meet him and tell him why I didn’t take surgery. I was probably sheepish about it – but his example was a wonderful one for me to follow – it just so happened that I headed in another direction. This book in many ways was my tribute to surgery – almost doing it vicariously – doing surgery without having done surgery! A tribute to how much I had enjoyed it.”

Dear Dr. Verghese,
Please keep doing all that you do. I am a nurse at Egleston Children’s Hospital of Atlanta. My brother is a neurologist at Shands in Gainesville, Fl.

Having worked with and socialized with internists, surgeons, and men of letters, I loved discovering someone who had mastered all three and thus retained his compassion for fellow human beings. In both memoir and novel you expose your wisdom, your strength, your vulnerability, your humanity. Bravo.

I agree with you 100% that truth lies in fiction. I have been passing books around for years to encourage my friends and family and coworkers (total strangers for that matter) to walk in someone else’s shoes.

My son’s middle school writing teacher at Paideia (previously a book reviewer for the AJC) has been my most bountiful resource for good reads. ‘Cutting for Stone’ was his summer read. I spotted him poolside when swimming laps.

Again, God bless you in all you do. Please keep writing and keep finding beauty and passion in the obvious and the hidden. Never lose your humility.
Chris

Hi Chris,
Thank you for responding to the profile/interview with Dr.Abraham Verghese. I have passed your letter on to him and have also shared some of your insightful comments with our readers. I am sure many of them will agree with you!

Dear Dr. Verghese
I am a nurse who studied in one of the Christian missionary nursing schools in Kerala. Now I work as an operating room nurse in Greenwich Hospital, Connecticut.
Your book ‘Cutting for Stone’ was recommended to me by one of the surgeons who was born and brought up in Zambia and migrated to USA.
I went to the library to get the book and to my surprise they told me they have 40 copies and all in circulation, and another 45 reservations. Anyway, I could get a book in two weeks and I started reading it on a Friday evening and never put down the book till both my shoulders started aching and only to to interrupt my reading only to meet my essential needs.
I traveled with Mary Joseph Praise, I lived in Hema’s household, I cried and laughed with them. My heart burned to meet a doctor like Ghosh. When I slept few hours on the nights of Friday and Saturday, I dreamed about them.
Dr Verghese…I was a serious reader and the last book I read was ‘God of Small Things’. I started studying for my RN and could never catch up on reading again because I relocated to Europe, and later to USA.
I can’t explain my gratitude to you for writing a book which made me rediscover my greatest hobby – reading – and I am so proud of you because your parents belonged to my own country and my state … Kerala.
I lived near Chennai for 20 years before I migrating. I could connect and identify with every one of the characters in your book.
Please continue writing.
My whole OR now is either reading the book or is in the process of getting one.
They were so amazed that Christianity existed in Kerala from 52 AD. They never believed me when I told them my surname is John. They thought I changed it after I came here.
Thanks again.

Emilie and Sophy, thanks for your comments. Both of you had addressed your comments to Dr. Verghese so though I am sharing them with readers, I will pass them on to him. I am sure he will be happy to hear how deeply affected you are by his work.

Thanks Lavina, for the wonderful page and for sharing the comments from Emilie and Sophy and Chris with me. It is great to visit this page and see all the comments. I am most grateful.

This week will be the 20th week that CUTTING FOR STONE has been on the New York Times bestseller list, and I am thrilled. It seems to be entirely fueled by word-of-mouth, which is lovely. Many thanks to you and to your readers for being at the heart of that word of mouth.

I enjoy your website very much and thanks for all you did to spread the word about C for S.

Thanks for writing in – I’m sure your fans will be delighted to see your interaction on this page! Congratulations on the continued success of Cutting for Stone – this feature about you and the book gets a lots of hits which makes me feel there is an evergreen appeal to it.

I would like to express my joy and appreciation that a person who was born in my country of origin, Ethiopia, could turn out to be a renowned medical doctor and writer.

I am grateful that you brought to the surface the most burning issue of the procedures of patients’ treatment in this country, where the human touch has been “sterilized.” Every time I visit a clinic due to an ailment, the doctor has only about 15 minutes during which he/she asks me some questions, looks at my medical history on the computer and never touches me and eventually leaves.

In many years of clinical visits, I never got healed.

We sometimes feel that we need to go back to our country to get a proper and more humane treatment, where doctors touch you thoroughly to locate the spot of the pain; talk to you in detail and try their best to heal you.

Perhaps you could establish such clinics in America and help people in a genuine way.

Dr. Verghese, I just finished reading your book Cutting For Stone, it was such a pleasure to read. It is the kind of book you want everyone you know to read so they too can have the pleasure of reading such an interesting and beautifully written book. I have since read a few articles about your practice and outlook on medicine. I agree with Kano Banjaw who left a comment on this page about how “sterilized” a visit to the doctor has become. I would rather be anywhere else than sitting in a doctor’s office with the feeling I am taking up his time. Looking forward to reading your future books.

I read your book ‘Tennis Partner’ when I was still waiting for ‘Cutting for Stone’ from the library. My uncle – a physician, recommended this book. I don’t have a medical background, but am a writer and a student of public policies and administration. I still thoroughly enjoyed both books and found them very gripping.

C for S has been penned so sensitively and makes me respect the medical profession so much more. It moved me to tears. You are so right when you say that the pulse of a patient and the gentle touch of a doctor are very healing. In a way I feel a little bad that this is reducing, as doctors see more patients to make up for insurance, etc.
Reading your interviews, it made me feel that it is possible to follow two passions!
Thank you so much for sharing your story and good luck!

‘Cutting For Stone’ is a breathtaking work! I’d been thinking that at my age I was through with reading novels (needing no further “instructions for life”) but now I’m no longer so sure.

Thank you, dear Doctor (“Doctor” was my childhood name for my beloved grandfather who was a physician and a surgeon) for taking me on a memorable journey, through laughter and tears and sometimes both at once.

I cannot begin to tell you how much I enjoyed your book, “Cutting for Stone.” I read the book at the recommendation of my sister who also enjoyed your book immensely. We were amazed at how real the characters were and how we could feel their emotions, especially that of Shiva and Marion. As we are identical twins (girls), we were amazed at how accurately you depicted a connection between twins. Just like the ShivaMarion of your book, we grew up as the BindhuBeena of our family and our community. Moreover, she is a surgical resident too.

We were also fascinated at all of your references to historical figures, geographical locations, etc., We are from Kerala, so that in itself made the mere mention of it delightful. Even your quick reference to St. Thomas coming to Kerala is something that popped out at us since we learned that in Sunday School growing up!

I want to thank you for a truly memorable book. The characters and the stories will forever create a lasting impression on me. I look forward to reading your other books.

This is turning into quite an Abraham Verghese fan page! Kano,Beverly, Bill, Pamma, Amishi, Linda and Beena – I will pass all your comments on to Dr.Verghese. He also does occasionally browse Lassi with Lavina – so I’m sure he’s aware of what his work means to you. It is remarkable how personal the book is to all of you.
Will keep you posted on his new work.
Lavina

I just wanted to say how much I am enjoying CUTTING FOR STONE. I have nearly finished reading the book and have found it wonderfully compelling. One of my sons is a consultant anesthetist in the UK which has made it even more interesting. It gives me more idea of what life in a surgical theater is actually like. My other son is called Tristan like Mr. Verghese’s son.

I hope Abraham Verghese will write some more books. It must be difficult for him to find the time but he has a great talent. I shall be recommending the book to all my friends and will be seeking out another one for myself.

Mary, thanks for your comments. You are in good company – so many seem to have enjoyed ‘Cutting for Stone’. However, while you wait to read Abraham Verghese’s next book, you can read some of the earlier works of non-fiction: ‘My Own Country’ and ‘The Tennis Partner’.

Dear Dr. Verghese,
I finished your marvelous book, “Cutting For Stone”, last night. I can’t remember when I enjoyed a book so much. I became fully immersed in the characters and settings. I am an RN, though no longer practicing, and believe my background in obstetrics and surgery made some of the details even more enjoyable to read.
There are so many wonderful things to say about the book I wouldn’t know where to begin.
Thank you for this story. I plan to pick up your other books!
Best regards,
Leslie Tucker Jenison
San Antonio TX

I am an artist in Fresno Ca. I have read tens of thousands of books in my life. I have never enjoyed a story more and this is the first time I have written a letter to anyone famous or even someone I don’t know. I felt I had to tell you that Cutting for Stone is my lifetime best read. As an artist myself I struggle with keeping on track at times. How in the world you can write such a masterpiece and having it take years is beyond me. It was so worth it, We will all enjoy your books.

We all strive in our artistic lives to be noticed or at least somewhat known in our creative endeavors , that has not been my fortune at least not to my satisfaction but I am happy to tell you that your goals have been reached. Keep on with your fascinating life’s work. Regards, Nipper

Lavina, thanks for alerting me to these wonderful comments. I am delighted to read these messages. Your readers might be interested in the fact that NPR Book Club this month has picked the book and there is a month long online discussion of the book going on (with me answering questions) on Facebookhttp://www.facebook.com/#!/topic.php?uid=175530655810201&topic=495
Again, thank you all for the kind comments
Abraham Verghese

Dear Dr. Verghese
I live in Brazil and had no idea about living in Ethiopia, about so many details from that country and even the continent… I’ve just read Cutting for Stone and I loved it! It is more than a story about medicine, more than a story about twin brothers, more than a novel about some lives… Sometimes, I started to cry reading the pages, not just with the story, but mostly with the wonderful way you used to tell it. I think maybe Hollywood might put these wonderful words on the big screen… I congratulate you for such a beautiful book and I am expecting your next story!
Adriana

Dr Verghese,
We are going to have a discussion on your book in our book club at the hospital I work in Tennessee. I am looking at all the websites to know more about you..
Just a request. I intend to read “Cutting for Stone” but one of the comments here is a spoiler (from a person called Emily) Please remove it. It spoils the intrigue.